Connect With A Child – Women’s and Children’s...
Transcript of Connect With A Child – Women’s and Children’s...
12/1/2014
Connect With A Child – Women’s and Children’s Hospital Organizational Plan
Tom Abungu and Gregory Dunn, MD CONNECT WITH A CHILD
UNIVERSITY OF TENNESSEE – PEMBA 2014 ADVISOR: DON CLARK
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Table of Contents Executive Summary ....................................................................................................................................... 3
The Kenyan Healthcare Industry ................................................................................................................... 4
Market Analysis ............................................................................................................................................. 4
Overview ................................................................................................................................................... 4
Demographic ............................................................................................................................................. 4
Economic ................................................................................................................................................... 5
Political ...................................................................................................................................................... 5
Force Field Analysis ................................................................................................................................... 6
Survey results of Siaya Residents .............................................................................................................. 8
Figure 1 – Cumulative Survey of Siaya County Residents ..................................................................... 8
Figure 2 – Survey of Siaya county leaders, physicians, nurses and teachers - ..................................... 9
Competitive Analysis ..................................................................................................................................... 9
Figure 3 – Competitive Structure Analysis .......................................................................................... 11
Marketing Plan ............................................................................................................................................ 12
Marketing to Financial Benefactors ........................................................................................................ 12
Marketing to Patients ............................................................................................................................. 12
Management Plan ....................................................................................................................................... 13
Overview ................................................................................................................................................. 13
Board of Directors ................................................................................................................................... 14
Committee Assignments ......................................................................................................................... 15
Operating Plan ............................................................................................................................................ 15
Overview ................................................................................................................................................. 15
Timeline................................................................................................................................................... 15
Staffing .................................................................................................................................................... 16
Figure 4 – Proposed Staffing Model (USD) ......................................................................................... 16
Building ................................................................................................................................................... 16
Equipment ............................................................................................................................................... 17
Ancillary Services .................................................................................................................................... 17
Figure 5 – Anticipated patient volume and charges ........................................................................... 18
Financial Plan .............................................................................................................................................. 19
Facility initial capital funding .................................................................................................................. 19
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Facility sustainment funding ................................................................................................................... 19
Cost Structure ......................................................................................................................................... 19
Proforma Income Statement .................................................................................................................. 20
Proforma Statement of Cash Flows ........................................................................................................ 20
Proforma Balance Sheet ......................................................................................................................... 20
Conclusions ................................................................................................................................................. 21
Appendix 1 – Tentative Hospital Design ..................................................................................................... 22
Appendix 2 – Survey used to interview Siaya residents ............................................................................. 23
Appendix 3 – Location of Hospital within Kenya ........................................................................................ 24
Appendix 4 – Cumulative Survey of Siaya County Residents ...................................................................... 25
Appendix 5 – Survey of Leaders within Siaya County ................................................................................. 26
Appendix 6 – IMEC Equipment Cost Estimate ............................................................................................ 27
References .................................................................................................................................................. 28
Abbreviations .............................................................................................................................................. 28
Slide Presentation ....................................................................................................................................... 29
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Executive Summary
Connect With A Child is a dynamic and rapidly growing, not-for-profit Christian organization
which reaches out to the poorest of Kenyan children. Our existing partnerships with individuals
and churches throughout the world have enabled us to provide Christian education, food, and
shelter to more than 300 children in need. Our success within Siaya County spurred a generous
individual to donate land for the purposes of building a hospital. With this donation and
through our research, we have discovered a substantial, unmet need for quality obstetrical and
pediatric medical care within Siaya County.
Kenyans are needlessly suffering through malnutrition, disease, and injury. One out of 11
children in Siaya county dies before the age of 1 (http://medicine.unm.edu/globalhealth/, n.d.).
HIV/AIDS is rampant in Siaya county residents, and resources are limited. With the government
of Kenya facing significant financial difficulty, the funds to establish a hospital are non-existent.
Women and children face the brunt of struggles within Kenya; gender equality issues, high
death rates, and daily financial struggles result in mothers and their children frequently working
long hours, making them unable to improve their futures through education. Siaya County’s
high maternal death rate creates numerous orphans who must beg for daily necessities.
By improving maternal and pediatric health, we aim to mitigate burdens generated by poor
health within Siaya County and create opportunities to share the love of God. With this goal as
our inspiration, we have developed a cost-efficient, targeted business plan to build a Women
and Children’s Hospital within the town of Udenda in Siaya County. Initial funding for this
hospital will be established through the generous donations of our international partners.
Hospital sustainment funding will be generated from a staggered billing system with service line
differentiation. By creating private rooms and additional amenities, we aim to attract clientele
who are willing to pay higher rates for a personal medical care experience. Segmentation of
care within our facility will generate additional revenue necessary to meet our organizational
budgetary requirements and allow us to touch individuals across all socioeconomic classes.
Connect With A Child Women’s and Children’s Hospital (CWACWCH) will maintain judicious and
honest financial accountability, with an organizational structure including a board of directors
who will be instrumental in financial oversight. Intelligent efficiency will be paramount in
ensuring that our partners’ generous contributions are maximized to their full benefit. As the
project advances, necessary partnerships will be generated with external organizations that
share CWACWCH goals. By partnering with CWACWCH today, individuals will have the
potential to invest in Africa’s future and share the love of God with the Siayan community.
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The Kenyan Healthcare Industry
Kenyan Healthcare is delivered by a mix of government-run hospitals; not-for-profit, faith-based
hospitals; and for-profit hospitals. The for-profit hospitals are mainly clustered within the large
cities. In many hospitals, care is only delivered if the patient has proof of insurance or cash-in-
hand. Delays in healthcare occur if proof of payment is not available—regardless of the
severity of injury or illness. There is no social healthcare safety net within Kenya although some
of the government-run hospitals will provide subsidized care. Advanced technologies, such as
CT scanners, are mainly limited to large hospitals in metropolitan areas. Not-for-profit centers
are believed by many Kenyans to offer better care to their patients. Kenya has eight provincial
hospitals that provide advanced ICU-level care and two national hospitals which provide full-
service specialty care. Infectious disease and trauma are the major causes of death within
Kenya. Healthcare insurance coverage is available in Kenya, and medicines are provided by the
government free-of-charge to hospitals.
Market Analysis
Overview
Siaya County is a poverty stricken region with high HIV/AIDS rates, high birth rates, high
childhood death rates, and low access to medical care. It is also a region with endemic malaria,
which further complicates healthcare delivery. Healthcare delivery consists of a mixture of
government-owned hospitals and small regional care centers. Quality of care varies
extensively, and the majority of would-be patients seek care over an hour away in Kisumu.
Dependable pediatric and obstetrical care would offload the main county hospital and decrease
access to care difficulties.
Demographic
Connection Women and Children’s Hospital will be based in Udenda within Siaya County,
Kenya. Udenda is located within western Kenya adjacent to Lake Victoria (Appendix 3). The
region has an infant mortality rate of 95/1000 births and a maternal HIV rate of 40 percent
(http://medicine.unm.edu/globalhealth/, n.d.). Malaria is endemic to this region, and hospitals within
this region are overcrowded and possess limited capabilities. The proposed obstetrical and
pediatric hospital would immediately serve 41,564 people; but as service capabilities improve,
the hospital potentially could care for a referral area of more than 200,000 people (www.opendata.go.ke/, n.d.).
Kenya’s children face many substantial challenges. Seventy-five percent of Kenya’s 29 million
people are under the age of 30 (World Bank, n.d.). Secondary school is not paid for by the
government, and enrollment is only 23.5 percent within Siaya (World Bank, n.d.). Primary school is
free; however, parents are responsible for children’s uniforms, food, and health care. This puts
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a substantial financial burden on parents, and unexpected expenses are challenging for families
to pay. Forty percent of children work more than 41 hours per week with approximately 50
percent of children contributing more than 50 percent of the household income (World Bank,
n.d.). This is partially due to the high parental death rate from HIV/AIDS. Of the 7.7 to 10.6
percent of children who report that they participated in commercial sex, 15 - 16 percent
reported that they began this work for money (World Bank, n.d.). One in ten Kenyan women have
attempted suicide, and in 2002 approximately 24 percent of 15 - 24 year olds were HIV positive.
These statistics, along with rapid population growth, point to the tremendous need for
improved healthcare delivery and infrastructure for Kenyan mothers and children.
Economic
Siaya County has some economic growth possibilities, but growth has been stagnated by
political corruption and civilian unrest. While there is potential for agricultural and industrial
projects to improve the economic conditions in this region, the poorest residents do not work
within these industries and continue to live off subsistence farming. Many Kenyans possess
one or two cows, a few chickens, and a small plot of land, and much of the growing industry
does not improve the lives of these local Kenyans. Rather, college-educated Kenyans are
brought in from Nairobi to staff many of the regional positions. In addition to the above
hurdles, Siaya County has limited broadband capability, poor roads, and a temperamental
electrical grid. Tourism was previously a strong industry that has been substantially weakened
by violence and Somalian terrorism.
Political
Kenya’s current president, Uhuru Kenyatta, was accused of ethnic violence in 2007 during an
election. As a result, President Kenyatta has been referred to the International Criminal Court
for prosecution, and this ongoing issue has dampened Kenya’s standing on the world stage.
The surrounding violence resulted in the deaths of more than 1,000 people and displaced an
estimated 600,000 people (CBS News, 2008). The stable reputation that Kenya had within Africa
was harmed and has resulted in a drop in tourism (Daily Nation, 2014). Kenya has further damaged
its international reputation regarding human rights with worsening policies involving gender
and racial equality.
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Force Field Analysis
Positive Forces
Demographic
o Siaya infant death rate of 95/1000
(World Bank, n.d.), maternal HIV rate of 40% and overcrowded government hospitals validate growth potential.
(http://medicine.unm.edu/globalhealth/, n.d.)
o Kenya’s youth literacy rate of 93% improves chances for sustained healthcare improvements.
(www.unicef.org, 2014)
o Number of physicians increased 31% between 2002 and 2009. (Dogbey, 2012)
o Hospital would serve a community of 45,000 with a population density of 290 people/km2. (www.opendata.go.ke/, n.d.)
Socio-Cultural
o Siaya County is 80% Luo people which is a group with strong social and political unity. (www.kwaho.org, n.d.)
Political
o The Luo people are the third largest ethnic group (13%) in Kenya and they are the second most politically influential behind the current Kikuyu government. (Country Profile: Kenya,, June 2007)
o Between 2008 and 2013 the prime minister of Kenya was Luo, and improvements in roads and infrastructure were realized in Siaya.
Negative Forces
Demographic
o Less than 1 physician per 100,000 patients in rural areas of Kenya. (Soucat, Scheffler, & with Tedros Adhanom Ghebreyesus, 2013)
o 42% of the population in Kenya is less than 14 years old, and life expectancy is only 61 years.
o 59% of available government physician positions are unfilled. (Dogbey, 2012)
o 54% of rural Kenya population has access to clean drinking water, and 29% have access to sanitation facilities. (www.cia.gov/library/publications/the-world-factbook/geos/ke.html, n.d.)
Socio-Cultural o Kenyan law passed in March 2014
legalizes polygamy and is of significant concern to women’s rights. (Leposo, 2014)
Political
o Current president is undergoing trial International Criminal Court related to sectarian violence. A guilty verdict may limit international aid. (Q&A: Kenyan
leaders at The Hague (www.bbc.co.uk), n.d.)
o The Kikuyu people currently control
government and are the main
political rivals of Luo people. There
is a history of politically-related
violence (2007) against Luo people.
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Economic o Projected economic growth rate of
5% in 2014. (World Bank, n.d.)
o World Bank and IMF have resumed loaning money to Kenya after a corruption scandal in 2006.
o Industrial Production growth rate of 4.6%. (www.cia.gov/library/publications/the-world-
factbook/geos/ke.html, n.d.)
o The Nairobi Securities Exchange has a history of stability and is the most advanced market in the region.
(Kimenyi & Kibe, 2014)
Technology o Innovative wireless insurance
payment system is in place which increases low income patient access and healthcare reimbursement.
(changamka.co.ke, n.d.)
Geographical o Siaya county borders Lake Victoria
and its waters are used in trade, irrigation, and fishing.
o Siaya county’s annual rainfall is between 800-1600mm which is substantially greater rainfall than the 80% of Kenya that is arid and semi-arid (<800mm).
(www.siayacounty.com/environment.php, n.d.)
o Unique topography and diverse wildlife have the potential to improve Kenya’s tourism industry.
Economic o Poverty rate of 40% in Siaya versus
22% in Nairobi. (World Bank, n.d.)
o Unemployment rate in Kenya is 40%.
(www.cia.gov/library/publications/the-world-factbook/geos/ke.html, n.d.)
o Inflation rate for Kenya in 2012 was 9.4% (World Bank, n.d.)
o 78.5% of urban population are in the highest wealth quintile, versus 12.3% in Nyanza region where Siaya County is located. (Dogbey, 2012)
Technology o Electrical grid has a history of
frequent blackouts.
o No access to broadband internet: limited ability to teleconference and utilize medical research (Draft: The
National Broadband Strategy for Kenya, 2013)
Geographical o Only 17% of total land area has
agricultural potential; however, 24% of GDP is from agriculture.
o Siaya County’s proximity to rivers and to Lake Victoria increase mosquito population and result in high rates of malaria infections.
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Survey results of Siaya Residents
A total of 51 Siaya county residents were interviewed by Tom Abungu and his team (Appendix
2). Originally the survey was designed to be administered as an interview; but, instead, the
participants completed the survey by hand. The survey was not blind; however, due to the type
of question asked, we believe the information obtained adequately reflects trending ideas
within the community. Of the 51 surveys completed, 19 people surveyed were leaders in the
community. This subgroup consisted of physicians, teachers, nurses, and political leaders. We
wanted to verify that the regular citizen and the community leader had similar opinions
regarding a potential future hospital. The survey was also designed to assist in recognizing
community needs and to determine what service lines our hospital would provide.
Figure 1 – Cumulative Survey of Siaya County Residents - See Appendix 4
As illustrated by Figure 1, the majority of Siaya residents feel strongly about the need for both
pediatric care and obstetrical care. There also appears to be support for a new hospital and a
general opinion that the current local hospitals do not provide excellent care. Infectious
disease care is also a perceived need and, most interestingly, the survey results suggest that
paying money for high quality care would be expected. We are encouraged by these survey
results. Our decision to pursue pediatric and obstetrical service lines were substantially
influenced by these surveys, as well as WHO/World Bank demographic analysis. Ultimately our
own internal survey corroborates information obtained through demographic information
obtained through WHO/World Bank.
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Figure 2 – Survey of Siaya county leaders, physicians, nurses and teachers - See Appendix 5
After separating out the leaders from the general respondents of our Siaya county survey, we
feel that the majority of opinions showed similar trends. It is interesting to see that a greater
percentage of community leaders believed that local hospitals are providing excellent care.
This is expected since many of the leaders within this survey worked for these local hospitals.
Other than this question, our conclusions remained the same with both the cumulative survey
and the survey of Siaya leaders, healthcare workers, and teachers. It is encouraging that the
different groups both feel strongly about the requirement for a new hospital and agree about
Siaya County’s healthcare needs.
Competitive Analysis
The four hospitals listed below in the competitive analysis suffer from severe overcrowding and are perceived partners rather than competitors. Since the majority of care in Siaya is through government-sustained hospitals, it is essential that we excel in quality and perceived quality of care. This will allow us to capture patients who are able to pay and will improve our long-term sustainment.
The only hospital that can be viewed as a direct competitor below would be Siaya District Hospital (SDH). Within SDH, many patients share beds and some women are discharged less than a day after childbirth. SDH provides obstetrical care, general surgical care, medical care,
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and pediatric care. It does not have neurosurgical, advanced ENT, advanced orthopedics, or advanced urological care. As noted, this hospital is our largest direct competitor and faces substantial overcrowding.
Siaya District Hospital o Largest hospital in region with 240 beds o Known service lines: surgical and nonsurgical maternity care, HIV care, pediatric
ward, general surgery, malaria treatment, nutrition, immunization, outpatient medicine
o Distance from Udenda – 11 miles
Bondo District Hospital o 49 beds o Known service lines: family planning, surgical and nonsurgical maternity care,
HIV care, malaria treatment, nutrition, pediatric ward o Distance from Udenda – 24 miles
Ambira Sub-District Hospital o 50 beds o Known service lines: family planning, HIV care, outpatient care, nutrition, malaria
treatment o Distance from Udenda – 12 miles
Uradi Mission Hospital o 18 beds o Very limited capabilities o Nurse-delivered care o Distance from Udenda – 1.5 miles
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Figure 3 – Competitive Structure Analysis
Kenyan Healthcare Education Pharmaceutics
Critical Access Hospitals
<30km from Udenda
town, Siaya county
Dispensaries Medical
Centers
Referral
Hospitals
Specialty
Hospitals
Critical
Access
Hospitals
Government
Owned Non-Profit/Charity
Healthcare
Facilities
Kenyan healthcare
facilities >30km from
Udenda town, Siaya county
Siaya
District
Hospital
Bondo
District
Hospital
Ambira
Sub- District
Hospital
Proposed
Udenda
Hospital
Uradi Mission
Health Centre
Brand Product
sub-subtype
Generic
Product
Product
type
Outpatient
Facilities
Inpatient
Facilities
Product
subtype
Product sub-
sub-subtype
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Marketing Plan
Connect With A Child Women and Children’s Hospital will need to market its services to two
distinct entities: patients and financial benefactors.
Marketing to Financial Benefactors
To build a self-sustaining, community hospital we must ensure the hospital’s initial endowment
is adequate to cover the initial building costs, to fully equip the hospital and to sustain
operations without encountering a short term cash-flow crunch. Developing a shared vision
with potential benefactors is essential. Historically, Connect With A Child has raised funds
through churches and through individual church members. Raising money in this way will
remain instrumental to our success; however our organization anticipates establishing
corporate and potentially governmental partnerships to ensure we meet our fundraising needs.
Early in the fundraising process CWACWCH will network with organizations such as Samaritan’s
Purse to ensure our business plans, organizational goals and funding outlooks are consistent
with historical projects and to identify and mitigate knowledge gaps in our planning process.
The first step in marketing to benefactors is to establish assurances that donated money will be
administered honestly, economically and effectively within our organization. Creating
partnerships with well-respected organizations will ensure that future benefactors are
confident in CWACWCHs mission and capabilities. All money raised for this project will be
maintained by Connection Church (Oregon City, OR). These funds will remain transparent with
financial records accessible to any fundraising partner.
As a non-denominational, Christian organization, CWACWCHs sole purpose is to share God’s
love by caring for those in need. Our hospital will be open to any international volunteers who
share this purpose. CWACWCH will maintain its support network through monthly newsletters,
blogs and direct communication with instrumental individuals. Establishing and sustaining this
our network with like-minded individuals will be critical to meeting our staffing and fundraising
needs.
Finally, CWACWCH desires to establish partnerships with corporate and governmental
organizations. To establish these networks a strict organizational structure, precise financial
planning and disciplined administrative oversight is important. Since CWACWCH is a new
entrant in the non-profit charity hospital market, remaining open to external input from
partner organizations will strengthen our financial foundation and ensure the longevity of our
hospital.
Marketing to Patients
Creating compelling service which attracts Kenyans to our hospital is essential to future hospital
stability. It is essential that initial planning steps focus on providing world class care that is
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affordable. We will need to identify high quality, Kenyan physicians who can partner with
volunteer international medical providers to develop a health care system that focuses on
quality. Spearheading an aggressive early approach to establish a strong, safe hospital culture
will be essential for our organization’s reputation. Only through establishing a reputation for
high quality care at the start can we ensure CWACWCH succeeds financially and
organizationally.
Early marketing strategies should focus on two different areas; creating awareness and enticing
wealthier Kenyans. Our marketing survey has already established there is tremendous demand
for our services. Creating awareness of our hospital will be the first step to ensure we have
adequate case volume to support our service. Awareness will be established through fliers,
school networking and word of mouth. Linking up with community leaders and communicating
our organizational needs will also be important for increasing community awareness.
Since we are offering a premium service line with private rooms we need to ensure our
reputation for service starts early and is maintained. Encouraging wealthier Kenyans to utilize
our private rooms will ensure financial stability in future years. It may be necessary to develop
unique marketing strategies to entice these customers to utilize our facility. Additional tailored
marketing approaches and research will be undertaken closer to hospital completion to ensure
our services meet premium criteria.
Management Plan
Overview
Connect With A Child Women and Children’s Hospital (CWACWCH) will be managed by a chief
executive officer overseen and elected by a majority vote by the board of directors. There will
also be an executive committee elected by majority vote who will act locally on the board’s
behalf. The executive committee’s organization will be solely determined by the board of
directors.
The board members’ terms will be lifetime positions. Members may remove themselves
voluntarily from the board of directors at any time. There are no financial benefits or incentives
to be a CWACWCH board member. To remove a board member from the board of directors
will require a two-thirds vote of the board of directors. A chairman will be elected by the board
of directors with a simple majority vote.
This hospital will be not-for-profit and will be affiliated with Connect With A Child. CWACWCH,
for legal purposes, will be a separate and unique organization from Connect With A Child.
CWACWCH is a Christian charity organization based in Kenya with offices in the United States.
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Our board of directors shall consist of dedicated, committed Christians with experience in
healthcare delivery, organizational leaders, or those who are influential members within the
local community.
Board of Directors
1. Tom Abungu, KENYA 2. Anna Abungu, KENYA 3. Jerry Weggener, Oregon City, OR 4. Hillary Abungu, KENYA 5. Jared Odhiambo, KENYA 6. Greg Dunn, Knoxville, TN
7. Zach Grafe, RioRancho/Abq, NM 8. Stephanie Jensenm, Ruidoso, NM 9. Evans Okeyo, Ruidoso, NM 10. Jacque Ochieng, KENYA 11. Pastor Dan Oketch, Kenya 12. Evelyn Osse, Kenya
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Committee Assignments
Connect with a Child will have, at least, the following three committees:
1. Governance Committee
2. Audit Committee
3. Finance Committee
Every board member should serve on at least one, but preferably no more than two,
committees. Members will be appointed by the chairman in consultation with the Governance
Committee. Committee size will depend on the needs of the board and the needs of the
organization, depending upon a given committee’s workload. Each board member should make
a commitment to actively participate in the work of their assigned committee.
Operating Plan
Overview
CWACWCH will have a ward with private rooms and more personalized service to cater to
individuals who have the ability to pay or have medical insurance. The hospital will also have a
separate pediatric ward and obstetric ward that has dividing curtains to provide medical care
for those who are less able to pay. By offering a two-tiered service model we can utilize our
higher revenue product line to financially supplement our mission to provide care for the
medically underserved in Kenya. We anticipate this two-tiered model to provide a greater level
of self-sustainment and improved growth.
Service lines offered at CWACWCH will be gynecological, women’s general and pediatric
surgical care as well as surgical and non-surgical obstetric care. CWACWCH will emphasize
standard, evidence-based medicine and will have some degree of medical oversight by
physicians from supporting countries. CWACWCH will actively recruit international and
domestic medical volunteers to ensure the hospital has exposure to diverse medical practices
which emphasize high quality.
Timeline
1/1/2015 6/1/20156/1/2015 6/1/20166/1/2016 1/1/20171/1/2017 1/1/2018
1/1/2015 - 5/31/2015
Fundraising Strategy / Networking
6/1/2016 - 1/1/2017
Fundraising
1/1/2018 3/1/2018
1/1/2018 - 3/1/2018
Recruitment / Hospital Equipment
1/1/2017 - 1/1/2018
Fundraising / Hospital Building
6/1/2015 - 6/1/2016
Fundraising / Grant Development
As a key project of Connect With A Child, CWACWCH will start active fundraising in the summer of 2015.
Initial grant development/grant exploration will start at this time and our key ministry partners will be
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contacted to explore early fundraising partners. Depending upon the level and types of grants received
CWACWCH will move into targeted fundraising by visiting ministry partners. Depending upon the status
of funds we will start construction of the hospital in January of 2017 with anticipated completion in early
2018. We anticipate approximately 3-4 months will be required for equipping the hospital and this time
will be used for staff recruitment.
Staffing
CWACWCH will predominantly be staffed by Kenyan-born and Kenyan-trained physicians. The
majority of the leadership and administrative structure will be Kenyan led. Physicians with
broad knowledge will be recruited as reflected in our proposed staffing model in Figure 4.
Figure 4 – Proposed Staffing Model (USD)
Building
Connect With A Child currently owns two acres of land within Udenda. This land has an
adequate well in place previously built by Connect With A Child. An additional, adjacent three
acres of land is available for purchase for approximately 3,000 USD. The building will have
three wings. The current design allows for two floors and is anticipated to cost approximately
2016
Employee
Cost
2016 Sa laries
2017
Employee
Cost
2017 Sa laries
2018
Employee
Cost
2018 Sa laries
2019
Employee
Cost
2019 Sa laries
2020
Employee
Cost
2020 Sa laries
Adminis trator 1 1 1 1 1
Adminis trator Cost 800.00$ 800.00$ 824.00$ 824.00$ 848.72$ 848.72$ 874.18$ 874.18$ 900.41$ 900.41$
Pediatrician 1 2 2 2 2
Pediatrician Cost 1,600.00$ 1,600.00$ 1,648.00$ 3,296.00$ 1,697.44$ 3,394.88$ 1,748.36$ 3,496.73$ 1,800.81$ 3,601.63$
OB/GYN 1 1 2 2 2
OBGYN Cost 1,800.00$ 1,800.00$ 1,854.00$ 1,854.00$ 1,909.62$ 3,819.24$ 1,966.91$ 3,933.82$ 2,025.92$ 4,051.83$
General Practice 3 3 3 3 3
General Practice Cost 1,600.00$ 4,800.00$ 1,648.00$ 4,944.00$ 1,697.44$ 5,092.32$ 1,748.36$ 5,245.09$ 1,800.81$ 5,402.44$
Surgeon 1 1 1 1 1
Surgeon Cost 1,800.00$ 1,800.00$ 1,854.00$ 1,854.00$ 1,909.62$ 1,909.62$ 1,966.91$ 1,966.91$ 2,025.92$ 2,025.92$
Nurse 9 9 10 10 10
Nurse Cost 678.00$ 6,102.00$ 698.34$ 6,285.06$ 719.29$ 7,192.90$ 740.87$ 7,408.69$ 763.09$ 7,630.95$
Nurse Ass is tant/Surgica l Ass is tant 5 6 7 7 7
NA/SA Cost 378.00$ 1,890.00$ 389.34$ 2,336.04$ 401.02$ 2,807.14$ 413.05$ 2,891.36$ 425.44$ 2,978.10$
Secretary 2 2 2 2 2
Secretary Cost 350.00$ 700.00$ 360.50$ 721.00$ 371.32$ 742.63$ 382.45$ 764.91$ 393.93$ 787.86$
Pharmacis t 1 1 1 1 1
Pharmacis t Cost 1,200.00$ 1,200.00$ 1,236.00$ 1,236.00$ 1,273.08$ 1,273.08$ 1,311.27$ 1,311.27$ 1,350.61$ 1,350.61$
Pharmacis ts ass is tant 2 2 3 3 3
Pharmacis t asst cost 250.00$ 500.00$ 257.50$ 515.00$ 265.23$ 795.68$ 273.18$ 819.55$ 281.38$ 844.13$
Lab Technician 3 4 4 4 4
Lab Tech Cost 250.00$ 750.00$ 257.50$ 1,030.00$ 265.23$ 1,060.90$ 273.18$ 1,092.73$ 281.38$ 1,125.51$
Cook 2 3 4 4 4
Cook Cost 172.00$ 344.00$ 177.16$ 531.48$ 182.47$ 729.90$ 187.95$ 751.80$ 193.59$ 774.35$
Housekeeping 5 5 5 5 5
Housekeeping Cost 172.00$ 860.00$ 177.16$ 885.80$ 182.47$ 912.37$ 187.95$ 939.75$ 193.59$ 967.94$
Guards 3 3 4 4 4
Guard Cost 215.00$ 645.00$ 221.45$ 664.35$ 228.09$ 912.37$ 234.94$ 939.75$ 241.98$ 967.94$
Nurse Midwife 4 4 5 6 6
Midwife Cost. 600.00$ 2,400.00$ 618.00$ 2,472.00$ 636.54$ 3,182.70$ 655.64$ 3,933.82$ 675.31$ 4,051.83$
Total Monthly Cost 26,191.00$ 29,448.73$ 34,674.46$ 36,370.33$ 37,461.44$
Total Yearly Cost 314,292.00$ 353,384.76$ 416,093.47$ 436,443.91$ 449,537.22$
Total Personnel 42 46 53 54 54
Gregory Dunn 17 12/1/2014
1.2 million in 2014 dollars. Our current plan is to frame the second floor and use it as storage
or dining in the first years of the hospital. As the hospital grows, the second floor will be
finished and repurposed for patient care purposes. Elevators will be added in the center of the
hospital.
The initial hospital floor plan limits entry to one primary door which allows for reduced staffing
and increased security, especially at night. Having outpatient facilities near the interior of the
hospital regulates patient inflow and ensures patient safety and building security (Wester, 2014).
It also places the physicians in close proximity to their wards and to their clinics so time can be
optimized
Equipment
CWACWCH has identified and collaborated with International Medical Equipment Collaborative
(IMEC) to equip and provide biomedical education for the hospital. IMEC repurposes donated
medical equipment to developing countries and designs an equipment plan based on
anticipated needs (IMEC America, 2014). This organization also has biomedical educators who can
ensure the hospital has adequate knowledge in maintaining medical equipment. Information
was obtained by email correspondence with Dr. Sue Crawford, IMEC’s African project
coordinator. Please refer to appendix 5 for CWACWCH equipment profile and proposed
equipment cost.
Christian Health Association of Kenya provides logistical support and biomedical repair for non-
profit member hospitals within Kenya. We have had discussions regarding this organization’s
services and anticipate utilizing CHAK’s expertise in maintaining our hospital equipment. CHAK
also has an extensive in-country hospital network and this organization will be an invaluable
resource for networking on CWACWCH’s behalf (Christian Health Association of Kenya, n.d.).
Ancillary Services
CWACWCH anticipates building an external kitchen with an open air dining area and additional
facilities which families can use to cook food. We will hire cooks to provide food for staff and
for our premium service patients. Meals will also be available for purchase. We would like to
build an external pavilion which can be used by patient’s families for sleeping in hammocks or
within cots. This would encourage families to remain involved in their family members care
while providing a free or discounted safe place to sleep.
Gregory Dunn 18 12/1/2014
Figure 5 – Anticipated patient volume and charges
2016 Monthly 2016 Yearly 2017 Monthly 2017 Yearly 2018 Monthly 2018 Yearly 2019 Monthly 2019 Yearly 2020 Monthly 2020 Yearly
Pediatric Visits/day 30 40 45 50 55
Pediatric Visits/month 600 7200 800 9600 900 10800 1000 12000 1100 13200
Average revenue per visit 20 20.6 21.218 21.85454 22.5101762
Total Revenue Pediatric Visits 12000 144000 16480 197760 19096.2 229154.4 21854.54 262254.48 24761.19382 297134.3258
Obstretric outpatient visits/day 25 45 50 55 60
Obstetric outpatient visits/month 500 6000 900 10800 1000 12000 1100 13200 1200 14400
Average revenue per visit 20 20.6 21.218 21.85454 22.5101762
Total Revenue Obstetric Visit 10000 120000 18540 222480 21218 254616 24039.994 288479.928 27012.21144 324146.5373
Non Premium Services
Obstetrical Deliveries/day 5 6 6.5 7 7.3
Obstetrical Deliveries/month 100 1200 120 1440 130 1560 140 1680 146 1752
Average revenue per visit 50 51.5 53.045 54.63635 56.2754405
5000 60000 6180 74160 6895.85 82750.2 7649.089 91789.068 8216.214313 98594.57176
Surgeries
Appendectomy # 5 6 6 6.5 7
Average revenue per appendectomy 150 154.5 159.135 163.90905 168.8263215
Total Revenue appendectomy 750 9000 927 11124 954.81 11457.72 1065.408825 12784.9059 1181.784251 14181.41101
Caesarean Section # 15 22 24 25 27
Average revenue per C-Section 200 206 212.18 218.5454 225.101762
Total Revenue C-Section 3000 36000 4532 54384 5092.32 61107.84 5463.635 65563.62 6077.747574 72932.97089
Hernia Repair # 15 22 24 25 27
Average revenue per Hernia repair 150 154.5 159.135 163.90905 168.8263215
Total Revenue per Hernia repair 2250 27000 3399 40788 3819.24 45830.88 4097.72625 49172.715 4558.310681 54699.72817
Pediatric (non-premium) Hospital Days per month
Number of Beds 15 15 15 15 15
Percent Capacity 75% 78% 80% 82% 85%
Revenue per patient day 50 51.5 0 53.045 0 54.63635 0 56.2754405 0
Total Revenue pediatric inpatient 16875 202500 18076.5 216918 19096.2 229154.4 20160.81315 241929.7578 21525.35599 258304.2719
Non Obstetrical (non-premium) Hospital Days per month
Number of Beds 10 10 10 10 10
Percent Capacity 75% 78% 80% 82% 85%
Revenue per patient day 50 51.5 0 53.045 0 54.63635 0 56.2754405 0
Total Revenue gynecological inpatients 11250 135000 12051 144612 12730.8 152769.6 13440.5421 161286.5052 14350.23733 172202.8479
2016 Monthly 2016 Yearly 2017 Monthly 2017 Yearly 2018 Monthly 2018 Yearly 2019 Monthly 2020 Monthly 2020 Yearly
Sum Total of Revenues - non-premium direct patient services 61,125.00$ 733,500.00$ 80,185.50$ 962,226.00$ 88,903.42$ 1,066,841.04$ 97,771.75$ 1,173,260.98$ 107,683.06$ 1,292,196.66$
Premium Services
Obstetrical Deliveries/day 2 2.2 2.3 2.4 2.5
Obstetrical Deliveries/month 40 480 44 528 46 552 48 576 50 600
Average revenue per visit 150 154.5 159.135 163.90905 168.8263215
6000 72000 6798 81576 7320.21 87842.52 7867.6344 94411.6128 8441.316075 101295.7929
Surgeries
Appendectomy # 1 1.1 1.2 1.3 1.4
Average revenue per appendectomy 250 257.5 265.225 273.18175 281.3772025
Total Revenue appendectomy 250 3000 283.25 3399 318.27 3819.24 355.136275 4261.6353 393.9280835 4727.137002
Caesarean Section # 4 4.4 4.84 5.324 5.8564
Average revenue per C-Section 300 309 318.27 327.8181 337.652643
Total Revenue C-Section 1200 14400 1359.6 16315.2 1540.4268 18485.1216 1745.303564 20943.64277 1977.428938 23729.14726
Hernia Repair # 4 4.4 4.84 5.324 5.8564
Average revenue per Hernia repair 250 257.5 265.225 273.18175 281.3772025
Total Revenue per Hernia repair 1000 12000 1133 13596 1283.689 15404.268 1454.419637 17453.03564 1647.857449 19774.28938
Pediatric (premium) Hospital Days per month
Number of Beds 5 5 5 5 5 5 5
Percent Capacity 40% 42% 44% 46% 49%
Revenue per patient day 100 103 106.09 109.2727 112.550881
Total Revenue pediatric inpatient 6000 72000 6489 77868 0 0 7589.80856 91077.70272 8208.377958 98500.53549
Non Obstetrical (premium) Female Hospital Days per month
Number of Beds 3 3 3 3 3
Percent Capacity 40% 42% 44% 46% 49%
Revenue per patient day 100 103 106.09 109.2727 112.550881
Total Revenue gynecological inpatients 3600 43200 3893.4 46720.8 4210.7121 50528.5452 4553.885136 54646.62163 4925.026775 59100.3213
2016 Monthly 2016 Yearly 2017 Monthly 2017 Yearly 2018 Monthly 2018 Yearly 2019 Monthly 2020 Monthly 2020 Yearly
Sum Total of all Revenue for premium direct patient services 18050 216600 19956.25 239475 14673.3079 176079.6948 23566.18757 282794.2509 25593.93528 307127.2233
Combined Revenue - premium + non-premium services 79,175.00$ 950,100.00$ 100,141.75$ 1,201,701.00$ 103,576.73$ 1,242,920.73$ 121,337.94$ 1,456,055.23$ 133,276.99$ 1,599,323.89$
Drug Revenue as percentage of combined revenue 3,958.75$ 47,505.00$ 5,007.09$ 60,085.05$ 5,178.84$ 62,146.04$ 6,066.90$ 72,802.76$ 6,663.85$ 79,966.19$
5%
Total Combined Revenue 83,133.75$ 997,605.00$ 105,148.84$ 1,261,786.05$ 108,755.56$ 1,305,066.77$ 127,404.83$ 1,528,857.99$ 139,940.84$ 1,679,290.08$
Gregory Dunn 19 12/1/2014
Financial Plan
Facility initial capital funding
CWACWCH anticipates high demand of our hospital services and a lack of foresight by under
sizing our hospital could lead to a diminished reputation. In order to ensure our regional
reputation and establish sustainable cash flow, we need depth and capacity within our pediatric
service lines. Appendix 1 illustrates a tentative 50-bed hospital design with an estimated 1.2
million USD build cost. Connect With A Child just completed building a 460,000 USD orphanage
in Nairobi and has connections with the necessary government organizations and builders to
achieve this goal.
International Medical Equipment Collaborative (IMEC) proposal for CWACWCH anticipates a
$195,000 initial equipment acquisition, repair and organization package. Shipping and setup is
not included in this amount and CWACWCH has budgeted $100,000 for equipment shipping
and setup.
As discussed in the marketing section, Connect With A Child’s existing fundraising connections
will be utilized for some of the funding requirements; however, we do not believe CWAC’s
current fundraising base is adequate to raise the estimated 2 million USD required for startup
expenses. This money will come from a mix of individual, governmental and corporate entities.
Facility sustainment funding
Our proposed facility would be uniquely differentiated from regional government hospitals
through two tiers of service depending upon a patient’s ability to pay. While patient care
quality will remain the same these tiers of service will be differentiated by food choices, room
privacy, and private bathrooms. With two tiers of service, we will improve our ability to
determine who is able to pay by patient self-selection while still meeting the core needs of the
region. Soliciting donations from Connect With A Child’s current fundraising base may be
required to meet ongoing budgetary needs however our goal is self-sustainment. It is possible
that money for capital expenditures will come from donations with sustainment funds coming
from hospital revenue. If successful at attracting higher income clientele to our facility, there is
the possibility that all sustainment needs could be met through healthcare billing.
Cost Structure
Similar non-profit African hospitals have the below anticipated cost structures (Wester, 2014):
1. Salary expense - 25-50%
2. Drug Cost - 25%
3. Upkeep - 10-15%
4. Inventory - 10-15%
Gregory Dunn 20 12/1/2014
We anticipate a slightly different cost structure because the Kenya government provides drugs
to hospitals. Anticipated cost structure excluding bad debt and depreciation:
1. Salary Expense – 50-60%
2. Upkeep 15-20%
3. Inventory – 15-20%
4. Drug Cost – 5-10%
Proforma Income Statement
Proforma Statement of Cash Flows
Proforma Balance Sheet
Income Statement 2016 2017 2018 2019 2020
Patient Care Revenues 950,100.00$ 1,201,701.00$ 1,242,920.73$ 1,456,055.23$ 1,599,323.89$
Drug Sales Revenue 47,505.00$ 60,085.05$ 62,146.04$ 72,802.76$ 79,966.19$
Expenses
Salaries 314,292.00$ 353,384.76$ 416,093.47$ 436,443.91$ 449,537.22$
Advertising/Marketing (.1% of revenues) 950.10$ 1,201.70$ 1,242.92$ 1,456.06$ 1,599.32$
Legal Fees (1% of Revenues) 9,501.00$ 12,017.01$ 12,429.21$ 14,560.55$ 15,993.24$
Depreciation (Straight Line) 54,312.50$ 54,312.50$ 54,312.50$ 54,312.50$ 54,312.50$
Electricity (inflation adjusted) 22,800.00$ 23,484.00$ 24,188.52$ 24,914.18$ 25,661.60$
Internet (Inflation adjusted) 5,472.00$ 5,636.16$ 5,805.24$ 5,979.40$ 6,158.78$
Yearly Inventory Expense/Supplies 108,000.00$ 121,433.43$ 142,981.99$ 149,975.00$ 154,474.25$
Drugs (15% of Salary cost) 47,143.80$ 53,007.71$ 62,414.02$ 65,466.59$ 67,430.58$
Maintenance (Hospital and Vehicle) 62,858.40$ 70,676.95$ 83,218.69$ 87,288.78$ 89,907.44$
Garbage/Sewage (as a percentage of Inventory Expense) 2,760.00$ 3,103.30$ 3,653.98$ 3,832.69$ 3,947.68$
Bad Debt (% of Revenues) 190,020.00$ 240,340.20$ 248,584.15$ 291,211.05$ 319,864.78$
Total Cost 818,109.80$ 938,597.72$ 1,054,924.69$ 1,135,440.70$ 1,188,887.40$
Net Income 179,495.20$ 323,188.33$ 250,142.08$ 393,417.30$ 490,402.68$
Statement of Cash Flows
2016 2017 2018 2019 2020
Beginning Cash Balance 2,000,000.00$ 833,807.70 1,191,309 1,475,763 1,893,493
Revenues less bad debt 807,585$ 1,021,445.85 1,056,483$ 1,237,647$ 1,359,425$
Salaries 314,292$ 353,384.76 416,093$ 436,444$ 449,537$
Advertising 950$ 1,201.70 1,243$ 1,456$ 1,599$
Legal Fees 9,501$ 12,017.01 12,429$ 14,561$ 15,993$
Electricity (inflation adjusted) 22,800.00$ 23,484.00 24,188.52$ 24,914.18$ 25,661.60$
Internet (Inflation adjusted) 5,472.00$ 5,636.16 5,805.24$ 5,979.40$ 6,158.78$
Yearly Inventory Expense/Supplies 108,000.00$ 121,433.43 142,981.99$ 149,975.00$ 154,474.25$
Drugs (15% of Salary cost) 47,143.80$ 53,007.71 62,414.02$ 65,466.59$ 67,430.58$
Maintenance (Hospital and Vehicle) 62,858.40$ 70,676.95 83,218.69$ 87,288.78$ 89,907.44$
Garbage/Sewage (as a percentage of Inventory Expense) 2,760.00$ 3,103.30 3,653.98$ 3,832.69$ 3,947.68$
Investing Activities
Fixed Assets 1400000 20,000 20,000 30,000 30,000
Total Investing Activities 1400000 20000 20000 30000 30000
Total Financing Activities -$ -$ -$ -$ -$
Cash Balance, End of Period 833,808 1,191,309 1,475,763 1,893,493 2,408,208
Balance Sheet
2016 2017 2018 2019 2020
Current Assets
Cash 833,807.70$ 1,191,308.53$ 1,475,763.11$ 1,893,492.91$ 2,408,208.09$
Inventories 10,800.00$ 12,143.34$ 14,298.20$ 14,997.50$ 15,447.42$
Long Term Assets
Net Fixed Assets 1,394,500.00$ 1,394,500.00$ 1,394,500.00$ 1,394,500.00$ 1,394,500.00$
Total Assets 2,239,107.70$ 2,597,951.87$ 2,884,561.31$ 3,302,990.41$ 3,818,155.52$
Current Liabilities
Debt -$ -$ -$ -$ -$
Equity -$ -$ -$ -$ -$
Common Stock -$ -$ -$ -$ -$
Retained Earnings 2,239,107.70$ 2,597,951.87$ 2,884,561.31$ 3,302,990.41$ 3,818,155.52$
Total Liabilities 2,239,107.70$ 2,597,951.87$ 2,884,561.31$ 3,302,990.41$ 3,818,155.52$
Gregory Dunn 21 12/1/2014
Conclusions Connect With A Child Women’s and Children’s Hospital is a unique organization that has the potential to
radically change thousands of lives. This hospital is a unique opportunity for a small investment of
money to reap enormous rewards for many years. Through self-sustainment and fiscal discipline,
CWACWCH will use its resources to enhance community health and save women and children’s lives.
With strong health care you will give this population an opportunity to progress out of poverty and to
build better futures for the children of Siaya County.
As you consider investing in Connect With A Child Women’s and Children’s Hospital realize that a single
investment in food or clothing will only help these individuals for a short time, CWACWCH will help them
their entire lives.
Gregory Dunn 22 12/1/2014
Appendix 1 – Tentative Hospital Design
Gregory Dunn 23 12/1/2014
Appendix 2 – Survey used to interview Siaya residents
Gregory Dunn 24 12/1/2014
Appendix 3 – Location of Hospital within Kenya
Gregory Dunn 25 12/1/2014
Appendix 4 – Cumulative Survey of Siaya County Residents
Gregory Dunn 26 12/1/2014
Appendix 5 – Survey of Leaders within Siaya County
Gregory Dunn 27 12/1/2014
Appendix 6 – IMEC Equipment Cost Estimate
Gregory Dunn 28 12/1/2014
References
CBS News. (2008, 02 11). Retrieved from http://www.cbsnews.com/news/un-600000-displaced-in-kenya-unrest/.
changamka.co.ke. (n.d.).
Christian Health Association of Kenya. (n.d.). Retrieved from CHAK: http://www.chak.or.ke/
(June 2007). Country Profile: Kenya,. Washington, DC: Library of Congress – Federal Research Division.
Daily Nation. (2014, 03 9). Retrieved from http://mobile.nation.co.ke/news/Tourism-Security-Kenya-Coast/-/1950946/2236932/-
/format/xhtml/-/15ly2e5z/-/index.html.
Dogbey, B. (2012). Kenya: Mobility of Health Professionals. Brussels: International Organization for Migration (IOM).
(2013). Draft: The National Broadband Strategy for Kenya. Government of the Republic of Kenya.
http://medicine.unm.edu/globalhealth/. (n.d.).
IMEC America. (2014, October 29). Retrieved from http://imecamerica.org/
Kimenyi, M., & Kibe, J. (2014, January 6). www.brookings.edu/research/opinions/2013/12/30-kenya-economy-kimenyi.
Leposo, F. K. (2014, May 1). New Kenya law legalizes polygamy; women's group applauds it. Retrieved from www.cnn.com:
http://www.cnn.com/2014/05/01/world/africa/kenya-polygamy-law/index.html
Miller, S. (n.d.). VP of International Operations - Cure International. (G. Dunn, Interviewer)
Q&A: Kenyan leaders at The Hague (www.bbc.co.uk). (n.d.). Retrieved January 29, 2014
Soucat, A., Scheffler, R., & with Tedros Adhanom Ghebreyesus, e. (2013). The Labor Market for Health Workers in Africa: A New Look at the
Crisis. Washington DC: World Bank.
Wester, T. (2014, September 2nd). MD, Medical Director, Gamboula Hospital, Central African Republic. (G. Dunn, Interviewer)
World Bank. (n.d.). www.worldbank.org.
www.cia.gov/library/publications/the-world-factbook/geos/ke.html. (n.d.).
www.kwaho.org. (n.d.).
www.opendata.go.ke/. (n.d.). Retrieved 2014
www.siayacounty.com/environment.php. (n.d.).
www.unicef.org. (2014, January 27).
Abbreviations
SDH – Siaya District Hospital
IMEC – International Medical Equipment Collaborative
CWAC – Connect With A Child
CWACWCH – Connect With A Child Women and Children’s Hospital
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